tbuckley/cabot-search huggingface dataset:
Abstract 12605: Sex Differences in Cardiovascular Revascularization Strategies and Outcomes in Dialysis Patients
Authors: Silvi Shah, Annette Christianson, Karthikeyan Meganathan, Anthony Leonard, charuhas thakar
Journal: Circulation (2022)

Background: Coronary artery disease is the leading cause of mortality in patients with kidney failure. Little is known about sex differences in revascularization strategies and the associated risk of death in dialysis patients. Methods: We evaluated 60,492 patients who initiated dialysis between 1/1/2005 and 12/31/2018 and had at least one hospitalization with a primary diagnosis of an acute coronary syndrome (ACS), using the United States Renal Data System with linked Medicare claims, we examined the association of sex with initial cardiac revascularization (defined as coronary artery bypass graft [CABG], percutaneous coronary intervention [PCI], or both on the same day) within 30 days of the first ACS hospitalization using adjusted multinomial regression, and the association of sex and initial cardiac revascularization on the outcomes of all-cause death and myocardial infarction using adjusted time-to-event models. Results: The mean age of patients at index ACS hospitalization was 72±11 years, and 40.4% were women. Overall, 40.5% received PCI, 20.8% received CABG, and 6.1% received both CABG and PCI. After an index ACS event, as compared to no revascularization, women as compared to men had a 41% lower likelihood of receiving CABG (OR, 0.59; 95% CI, 0.56-0.62), 13% lower likelihood of receiving PCI (OR, 1.48; 95% CI, 1.42-1.55), and 41% lower likelihood of receiving CABG and PCI (OR, 0.59; 95% CI, 0.55-0.64). Women had a slightly lower risk of all-cause death during the follow-up period than men without treatment (HR, 0.87; 95% CI, 0.85-0.90) or after receiving PCI (HR, 0.94; 95% CI, 0.90-0.97), but no difference in all-cause death after receiving CABG, and after receiving both CABG and PCI. Women had a higher risk of having MI after receiving CABG (HR, 1.12; 95% CI, 1.05-1.19), and a lower risk of MI after receiving PCI. Conclusion: Among patients undergoing dialysis with ACS, women receive less treatment with CABG or PCI than men. Women have a lower adjusted risk of all-cause mortality with PCI, a lower risk of MI after PCI, and a higher adjusted risk of MI with CABG, as compared to men. Revascularization strategies for CV disease may need to be modified based on sex.
Abstract 12505: Patients With Heart Failure Living in Socioeconomically Deprived Neighborhoods Have Unique Metabolomic Profiles
Authors: Alanna A Morris, Chang Liu, Eisha Udeshi, Rebecca Steinberg, Jeffrey Wang, Alexis K Okoh, Javed Butler, Dean P Jones, Arshed A Quyyumi
Journal: Circulation (2022)

Introduction: Patients living in neighborhoods with lower socioeconomic status have a greater risk for incident heart failure (HF), more severe symptoms, and increased risk of adverse clinical outcomes. We used high resolution metabolomics profiling to identify novel biomarkers associated with neighborhood socioeconomic status (nSES) in patients with HFrEF. Methods: The Area Deprivation Index (ADI) was used to characterize nSES in a discovery (n=170) and a validation (n=166) cohort of patients with HFrEF. Targeted and untargeted high-resolution plasma metabolomics profiling coupled with partial least-squares discriminant analysis (PLS-DA) was used to identify metabolites and metabolic pathways uniquely perturbed in patients in the highest tertile of the ADI (indicating lower nSES). Metabolites with a variable importance in projection (VIP) &gt; 1 entered pathway enrichment analysis. Results: Compared to patients in the lower and middle ADI tertiles, patients with HFrEF living in the highest ADI tertile were more likely to be Black, and had higher body mass index and lower ejection fraction (all P &lt; 0.01). PLS-DA confirmed metabolites that may be associated with worse diet quality in patients in both the discovery and validation cohorts who lived in neighborhoods in the highest ADI tertile, including amino acids and their metabolic products (carnitine, methionine, tryptophan, phenylalanine, valine, phenethylamine, indole), and urate. Moreover, metabolites associated with the human exposome (5-valerolactone, 1-naphthylamine) were also identified. Pathway enrichment analysis revealed branched-chain amino acid metabolism, fatty acid metabolism, and purine metabolism as part of this distinct metabolic signature ( Figure ). Conclusions: Patients with HFrEF living in neighborhoods with lower SES have a distinct metabolic signature that may, in part, be related to worse diet quality and more severe HF.
Abstract 12588: Inflammatory Pathways and High-Risk Coronary Plaque in Obstructive Coronary Artery Disease in The PROMISE Clinical Trial
Authors: Elizabeth Zhao, Stephanie Giamberardino, Neha J Pagidipati, Deepak Voora, Udo Hoffmann, Julia Karady, Maros Ferencik, Borek Foldyna, Pamela S Douglas, Svati H Shah
Journal: Circulation (2022)

Introduction: Two-thirds of CV events occur in patients without oCAD; vulnerable plaque (VP) has been implicated in its pathobiology. Inflammation plays a role in atherosclerosis, but the relationships between its pathways and related biomarkers in VP have not been comprehensively evaluated. Methods: The PROMISE trial randomized 10,003 patients with stable outpatient chest pain to CTA for coronary imaging vs standard of care. In this substudy, we measured 92 inflammatory proteins using the Olink platform in 1788 PROMISE participants with core-lab interpreted CTA and biospecimens. Principal component analysis (PCA) was used for dimensionality reduction and protein PCA factors were tested for association with a high-risk composite (HRC) phenotype (composed of: oCAD, CAC&gt;400, VP features and/or Leaman score&gt;5). Significant PCA protein factors (FDR q &lt; 0.05) were tested with individual HRC features. Results: The cohort was 53% female, had a mean age of 60, and 58% had a HRC phenotype. Of 12 PCA factors, three were significantly negatively associated and one was positively associated with HRC (Figure) including factors related to T-cell dependent responses (factor 6, p&lt;0.0001); cytokines (factor 9, p=0.005); chemokines (factor 5, p=0.01); and IFN-gamma related proteins (factor 3, p=0.04). Only factor 9 was associated with VP (OR: 1.14, 95% CI [1.002-1.28], p=0.04), but attenuated in multivariate models. For individual proteins: SCF, TRANCE, TWEAK, TRAIL and IL8 (OR 0.58-1.27, p=0.001 to &lt;0.001) were most significant, and all but IL8 were negatively associated with HRC. Conclusion: Leveraging a trial of individuals with stable chest pain and coronary CTA, we identified a range of inflammatory proteins and related pathways associated with HRC. These results implicate TNF-receptor binding (TRAIL, TRANCE) and cytokine pathways in high risk coronary atherosclerosis and highlight biomarkers with potential clinical utility for identifying high risk individuals.
Abstract 12578: Development and Validation of a Scoring System For Predicting Technical Failure During Percutaneous Coronary Interventions of Chronic Total Occlusions: The Updated PROGRESS-CTO Score
Authors: Judit Karacsonyi, Bahadir Simsek, Spyridon Kostantinis, Khaldoon Alaswad, Oleg Krestyaninov, Jai Khatri, Paul Poommipanit, Sevket Gorgulu, Farouc A Jaffer, MICHAEL KUTUZIS, Abdul Sheikh, Wissam Jaber, Stephane Rinfret, Robert Yeh, Ahmed El Guindy, OMER GOKTEKIN, Nidal Abi Rafeh, MD, FACC, Taral Patel, brian jefferson, Dimitrios Karmpaliotis, Ajay Kirtane, Margaret McEntegart, Olga Mastrodemos, Bavana V Rangan, Imre Ungi, Yader Sandoval, Salman S Allana, M Nicholas Burke, Emmanouil S Brilakis
Journal: Circulation (2022)

Background: Predicting technical failure in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) can assist with decision making and planning of the procedure. Methods: We analyzed 6,946 CTO PCIs performed between 2016 and June 2022 at 36 international centers in the Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO) and created a score for risk of technical failure. Logistic regression prediction modeling was used to identify independently associated variables with technical failure and model were internally validated with bootstrapping. Results: Mean patient age was 64.0±10 years, 82% were men and technical success was 86%. The following variables were independently associated with technical failure and were included in the final model: age (odds ratio [OR]: 1.08, 95% Confidence Intervals [CI]: [1.00-1.15], p=0.039; age≥ 65 years; 1 point), CTO length (OR: 1.13, 95% CI [1.10, 1.17]; length≥ 20 mm; 1 point), moderate/severe calcification (OR: 1.35, 95% CI [1.17, 1.56]; 1 point), proximal cap ambiguity (OR: 2.25, 95% CI [1.95, 2.59]; 2 points), lack of interventional collaterals (OR: 1.60, 95% CI [1.39, 1.84]; 1 point), and lack of good distal landing zone (OR: 1.51, 95% CI [1.31, 1.75]; 1 point). The resulting score showed acceptable performance on receiver-operating characteristic (ROC) curve, AUC: 0.68 (95% CI [0.67-0.71]). Internal validation with bootstrapping of 1000 samples demonstrated a good agreement with the model, observed AUC: 0.68, (95% bias corrected CI [0.67, 0.70]). PROGRESS-CTO technical failure score and corresponding risk percentage and the percentage of patients in the respective risk group within the PROGRESS-CTO registry are represented in Figure 1. Conclusion: The updated PROGRESS CTO score may be useful for assessing the likelihood of technical failure success in CTO PCI.
Abstract 11853: Prevalence and Correlates of Pre-Heart Failure Longitudinal Change in a Hispanics/latino Population-Based Study: Insights From the Echocardiographic Study of Latinos
Authors: Toshiki Kuno, Nestor Vasquez, Ayana April-Sanders, Katrina Swett, Jorge R Kizer, Bharat Thyagarajan, Gregory A Talavera, Sonia Ponce, Bonnie Shook-Sa, Martha L Daviglus, Mayank M Kansal, Jianwen Cai, Dalane W Kitzman, Carlos Rodriguez
Journal: Circulation (2022)

Background: Hispanic/Latinos have a high heart failure (HF) risk factor burden. Pre-HF is an entity known to progress to symptomatic HF. We aimed to characterize pre-HF prevalence and incidence among Hispanics/Latinos. Methods: The Echocardiographic Study of Latinos (Echo-SOL), a population-based sub-study of the Hispanic Community Health Study/ Study of Latinos (HCHS/SOL), assessed cardiac parameters on 1,643 participants at baseline and serially 4.3 years later. Prevalent pre-HF was defined as the presence of any abnormal cardiac parameter (left ventricular (LV) ejection fraction &lt;50%; absolute global longitudinal strain &lt; 15%; grade 1 or more diasolic dysfunction; LV mass index &gt;115 g/m 2 for men, &gt;95 g/m 2 for women; or relative wall thickness &gt;0.42). Incident pre-HF was defined among those without pre-HF at baseline. Sampling weights were utilized to account for the HCHS/SOL sampling design. Results: Among our study population (mean age: 56.4 years; 56% female), HF risk factors, including systolic blood pressure and glycosylated, worsened during follow-up. Significant worsening of cardiac parameters was evidenced from baseline to follow-up (p&lt;0.01 for all parameters). The extent to which cardiac parameters changed during follow-up varied across Hispanic/Latinos background groups with Mexican and Dominican descent having the greatest worsening of LV systolic and diastolic function. Overall, the prevalence of pre-HF was 66.7% at baseline and the incidence of pre-HF during follow-up was 66.3%. Prevalent and incident pre-HF were seen more among those with HF risk factors (Figure 1) as well as with older age. Conclusions: Hispanic/Latinos in the Echo-SOL target population exhibited worsening of pre-HF characteristics over time, with important Hispanic/Latinos background differences. Incidence and prevalence of pre-HF are high and pre-HF is associated with HF risk factors in our target population.
Abstract 11377: Takotsubo Syndrome Among Patients With Spontaneous Coronary Artery Dissection: A Report of the ISCAD Registry
Authors: Gerald Chi, Esther S Kim, sahar naderi, Katherine Leon, C M Gibson, Anna Grodzinsky, Heather L Gornik, Bryan Wells, Jennifer Lewey, Angela Taylor, Daniella Kadian Dodov, Connie N Hess, Stanislav Henkin, Kathryn Lindley, Gretchen L Wells, James L Orford, Lori M Tam, Dharam J Kumbhani, Samuel Norris, Cassandra Reyes, Fahad Alkhalfan, Clara Vitarello, Malissa Wood
Journal: Circulation (2022)

Introduction: Association of takotsubo syndrome (TTS) with spontaneous coronary artery dissection (SCAD) has been described previously. Characteristics and in-hospital prognosis of SCAD patients with concomitant TTS remain unclear. Methods: Patients with angiography-confirmed SCAD were selected from the iSCAD Registry and underwent core lab adjudication of left ventriculography (LVG) and coronary angiography including assessment of SCAD lesion characteristics, TIMI Flow Grade (TFG), and TIMI Myocardial Perfusion Grade (TMPG). Classic TTS was defined as wall motion abnormality (WMA) presenting as apical ballooning. TTS variants were defined as non-apical WMA discordant to dissected coronary territory with apical sparing. In-hospital event was defined as composite of recurrent myocardial infarction (MI), cerebrovascular accident, heart failure requiring diuretics, or new arrhythmia. Results: On blinded review of LVG from 216 patients, TTS was identified in 38 (17.6%) patients (classic, midventricular, and focal pattern: 86.8%, 2.6%, and 10.5%, respectively). There was no significant difference in age, cardiovascular risk factors, history of anxiety or depression, recreational substance use, emotional or physical stressors, extracoronary vascular abnormalities, peak troponin levels, or TFG of dissected arteries between TTS and non-TTS groups. TTS patients were more likely to present with ST-segment elevation MI (47.4% vs 27.5%; p=0.02), left anterior descending artery (LAD) involvement (89.5% vs 59.0%; p=0.0004), and TMPG &lt; 3 (68.4% vs 48.3%; p=0.02) compared to non-TTS patients. TTS patients had a greater risk of in-hospital events (32.4% vs 15.1%; p=0.01), mainly attributed to new arrhythmia (27.0% vs 6.5%; p=0.0009) and heart failure (11.4% vs 3.0%; p=0.03). Conclusion: Coexistence of TTS and SCAD was associated with ST-elevation MI, LAD involvement, impaired microvascular myocardial perfusion, and adverse in-hospital outcomes.
Abstract 11808: Association Between Weight Gain After Smoking Cessation and Future Hypertension
Authors: Yuichi Ninomiya, Shin Kawasoe, Takuro Kubozono, Akihiro Tokushige, hitoshi ichiki, Yoshiyuki Ikeda, Hironori Miyahara, Koichi Tokushige, Mitsuru Ohishi
Journal: Circulation (2022)

Introduction: While smoking cessation reduces the risk of ischemic heart disease and stroke, it may be associated with weight gain. However, literature on the association between weight gain after smoking cessation and future hypertension is scarce. Methods: Of the 234,596 individuals who visited our health checkup center, 1085 individuals (mean age 47.5 ± 10.6 years; 1005 men) with previous history of smoking and available data after 5 years of smoking cessation were included. We compared the relationship between weight gain after smoking cessation and future hypertension (changes in blood pressure [BP] from baseline to 5 years, following smoking cessation and prescription rate of antihypertensive drugs. Multiple regression analysis was performed to evaluate changes in systolic and diastolic blood pressures (SBP and DBP) using covariates affecting BP changes from baseline values, such as weight gain, age, baseline weight, sex, and habitual alcohol consumption. Results: Since a median weight gain of 1.7 kg was observed after 1 year of smoking cessation, we divided participants into two groups: high weight gain (547 individuals, ≥1.7 kg) and low weight gain (538 individuals, &lt;1.7 kg). There was no significant difference in the prescription rate of antihypertensive drugs between the two groups (high weight gain vs. low weight gain), at the baseline (10.6% vs. 10.4%; p = 0.92) and 5 years following smoking cessation (25.4% vs. 28.4%, p=0.26). Nevertheless, the changes in SBP (high weight gain vs. low weight gain: 7.9±15.4 vs 3.8±15.4 mmHg, p&lt;0.001) and DBP (high weight gain vs. low weight gain: 4.2±10.5 vs 1.1±10.8 mmHg, p&lt;0.001) from baseline to 5 years following smoking cessation were significantly higher in the high weight gain group. Additionally, multiple regression analysis showed that changes in SBP were influenced by high weight gain (β=-0.13, p&lt;0.001) and age (β=0.06, p&lt;0.05), while changes in DBP were influenced by high weight gain (β=-0.14, p&lt;0.001), age (β=-0.10, p&lt;0.001), and baseline weight (β=-0.10, p&lt;0.01). Conclusions: Our results suggest that weight gain following smoking cessation subsequently leads to hypertension, and weight loss guidance may be useful in such cases.
Abstract 11370: Acute Myocarditis Following a Third Dose of COVID-19 mRNA Vaccination in Adults
Authors: Anthony Simone, John Herald, Aiyu Chen, Rohith Nayak, Albert Yuh-Jer Shen, Mingsum S Lee
Journal: Circulation (2022)

Introduction: The COVID-19 mRNA vaccines are effective in reducing COVID-19-related severe disease and death. Waning vaccine effectiveness has prompted the recommendation to administer additional (booster) doses. With additional doses of COVID-19 mRNA vaccines being recommended, it is essential to monitor its safety. Myocarditis has been reported following the second dose of COVID-19 mRNA vaccination. Whether administration of additional doses of COVID-19 vaccines further increases the risk of myocarditis is not known. This study aimed to evaluate whether a third dose of COVID-19 mRNA vaccine was associated with an increased risk of myocarditis in a large population-based cohort in California. Methods: We included individuals who received one to three doses of BNT162b2 (Pfizer) or mRNA-1273 (Moderna) mRNA vaccine between 12/14/2020 and 2/18/2022 in an integrated healthcare delivery system in the United States. Hospitalization for myocarditis within 21 days of vaccine administration was identified using electronic medical records. Results: Of 3,076,660 KPSC members who received at least one dose of COVID-19 mRNA vaccines, 2,916,739 (94.5%) received at least two doses, and 1,146,254 (47.0%) received three doses. The IRR for myocarditis was 0.86 (95% CI 0.31-1.93) for the first dose, 4.87 (95% CI 3.14-7.37) for the second dose, and 2.61 (1.13-5.29) for the third dose. The majority of myocarditis cases following the second and third dose occurred within seven days of vaccination. Conclusion: Myocarditis was a rare but serious event observed after the second or third dose of vaccination. Most cases presented within seven days of vaccination. The incidence of myocarditis following the third dose did not appear to be significantly higher than that observed after the second dose.
Abstract 11992: Novel Immune Profiling Utilizing Single-Cell Mass Cytometry in Pediatric Heart Failure
Authors: Meghna D Patel, Amy Tsai, Mingming Zhao, Julien Hedou, Roger Luong, Anne C Taylor, Daniel Bernstein, Brice L Gaudilliere
Journal: Circulation (2022)

Introduction: Pediatric end-stage heart failure (ESHF) is a diverse disease with significant morbidity. Many children are supported with ventricular assist devices (VAD), adding further high risk of complication. Specific markers for adverse events are unknown. Emerging evidence suggests the presence of inflammation and immune dysfunction in ESHF. Improved understanding of systemic immune dysfunction is a first step towards identifying biomarkers of ESHF. We hypothesize that the distribution and signaling of innate and adaptive immune cells differ in pediatric ESHF and healthy controls. Methods: A high-dimensional, single-cell mass cytometry immuno-assay was used to quantify 247 cell signaling events in whole blood from children with ESHF (n=18) and healthy controls (n=12). Cell signaling was assessed at baseline and after stimulation. Multivariate regularized regression modeling with Elastic Net (EN) was used to identify differences between groups (fig. 1A). Secondary analyses evaluated effect of ESHF+VAD (n=6). Statistical significance was established using Leave one out cross validation. Results: We identified an EN model that stratified ESHF vs. controls with high accuracy (fig. 1B). Model analysis revealed cell-type and signaling differences that spanned innate and adaptive immune components. ESHF showed depressed endogenous gdT cell frequency, pERK signaling in ncMCs, and elevated pSTAT3 and pSTAT4 in CD4+ T cells in response to cytokine stimulation. Additionally, the model predicted differences in ESHF vs. ESHF+VAD with high accuracy (fig. 1C-D). Conclusions: Comprehensive single-cell analysis identified a robust immune signature of pediatric ESHF that was further modulated by presence of a VAD. Individual features revealed novel innate and adaptive immune dysfunction. Future prospective studies will be key to identifying immunological biomarkers that facilitate clinical decisions and predict complications in pediatric ESHF.
Abstract 11453: Age, Sex, and Outcomes in Heart Failure With Reduced Ejection Fraction: Insights From the VICTORIA Trial
Authors: Ileana L Pina, Yinggan Zheng, Diana Bonderman, Anne Pouleur, Clara Saldariagga, Burkert Pieske, Robert O Blaustein, Richard Nkulikiyinka, Cynthia M Westerhout, Paul W Armstrong, Carolyn S Lam
Journal: Circulation (2022)

Background: Both patient age and sex influence heart failure (HF) treatment and outcomes. Given women are generally older in HF trials, we examined the associations of age and sex with clinical characteristics, background HF therapy, and response to vericiguat in VICTORIA. VICTORIA enrolled 5050 patients with HF with reduced ejection fraction (HFrEF) and recent worsening HF, was broadly inclusive without an upper age limit, and included 28% women (n=1208), and 31% (1568 ) were ≥75 years old with event rates exceeding most HF trials. Methods: Clinical characteristics were compared across age groups (&lt;65, 65 to &lt;75, ≥75 and &lt;75, ≥75 years) and sex ( Table ). Results: More women (37%) than men (29%) were age ≥75 years. Compared with younger patients, those ≥75 had higher EF and class III/IV symptoms, more comorbidities, higher NT-proBNP and lower eGFR, indicative of more advanced disease; however, this age group had the lowest use of triple therapy. Within each age group, women had higher EF and lower burden of some comorbidities (atrial fibrillation, hyperlipidemia, coronary artery disease) compared with men, but similar functional status and NT-proBNP. There were no sex differences in the use of triple therapy by age group; however, women ≥75 years less often achieved target doses of triple therapy than men of similar age. Women were also less likely to receive HF devices across all ages. The incidence of the primary composite endpoint (cardiovascular death or HF hospitalization) increased across age groups and was higher in men than women. Compared with the pre-specified age subgroup analysis (i.e., &lt;75, ≥75 years), the beneficial effect of vericiguat on the primary endpoint was not modified by age (continuous) and sex (3-way interaction; p=0.847). Conclusions: Women in VICTORIA were older than men, and while elderly women received less intense background HF therapy, their prognosis was nominally better than elderly men. Vericiguat’s benefit was independent of age and sex.